In response to the request from Congresswoman Renee Ellmers—a fellow North Carolinian—to exempt soon-to-retire doctors and small medical practices from the federal requirement to use an electronic health record (EHR), I say ‘Not needed.’

I am 66 years of age and I adopted an EHR in January 2011, when I was 64. The upfront cost was reasonable and training was done without interrupting my schedule. In addition, since my vendor—athenahealth—is only paid if I am paid, they have a vested interest in making certain that claims are filed and paid in a timely manner.

For the first three months in 2011, I learned to use the system. During the next three months, I fulfilled all the requirements for Meaningful Use and I attested at the end of June. A few months later, I received my check for $18,000 without any significant hassle on my part—the attestation was all done by my vendor. 

I find that using the athenahealth electronic health record has greatly improved my documentation, virtually eliminated claims denials or resubmissions, facilitated communications with other health providers and patients, and has even reduced postage and office supplies. It did not impact my workflow because the system is easily modified (by me, not the vendor). Moreover, some of the requirements of Meaningful Use helped me deliver better patient care–like the requirement that I provide a clinical summary to patients after their visit.

Physicians of my age went to medical school during the ‘60s and ‘70s. The application process was very competitive and, as a result, they are all smart people. To imply that we are incapable of adopting and learning to efficiently use an EHR is nonsense. To the good Congresswoman, I would reply that her time could be better spent concentrating her efforts on bringing Medicare reimbursement in line with private insurance carriers.

Dr. Eubanks is an athenahealth client.

If you read the athenahealth blog regularly, you know we tend to write about and discuss Meaningful Use.

Often.

We have a good reason. We have approached Meaningful Use the way we approach everything we do—by working with our providers to get them paid for doing the right thing. To that end, we offered the industry’s only incentive guarantee, established a Meaningful Use Resource Center for clients, held a multitude of MU webinars and created a cross-functional team to tackle each problem clients might face. And our CEO, Jonathan Bush, pulled a Full Monty (of his data) while in Las Vegas for the MGMA convention last October.

Our approach worked! We helped 85% of our eligible, participating physicians attest to the Stage 1 measures and receive their incentive payments.

With so much blood, sweat and tears invested in the Meaningful Use of our EHR by providers, we jumped at the opportunity offered by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to provide comments in response to two sets of rules: The Meaningful Use Stage 2 Notice of Proposed Rulemaking (NPRM)—“CMS Rule”—and the 2014 Edition EHR Standards and Certification Criteria Proposed Rule—“ONC Rule”. In future posts, we’ll dig into key topics in greater detail but, for now, we thought it’d be helpful to summarize what we submitted on May 7th.

General Thoughts on the CMS and ONC Proposed Stage 2 Rules

We are highly encouraged by the inclusion and expansion of objectives and measures related to the exchange of health information, patient engagement, and quality reporting. The increased focus on these critical areas will lay the foundation for providers to leverage health IT to promote better care for individuals, improved population health and increased value in health care (aka the health care “Holy Grail”.)
Because there is often a variance between standards and their implementation, we believe a high degree of harmony between the ONC Rule and CMS Rule is fundamental to the Certified EHR Technology (“CEHRT”) vendors’ ability to help providers achieve Meaningful Use. We also think it’s vitally important for the ONC and CMS to create enough rules flexibility to encourage continued innovation. (PLEASE!)

In the specific case of health information exchange, we hope the ONC will consider the certification criteria as the minimum, baseline standard upon which existing and new means of electronic exchange can support providers in achieving Meaningful Use.

Last, we greatly appreciate the many ways CMS and the ONC have fostered a transparent rule-making process: public access to the Federal Advisory Committee meetings and recommendations; presence at industry events like the HIMSS12 conference; and, opportunities to participate in private-public collaborations. The efforts made by CMS and ONC representatives to educate the public on comment-making best practices have been great too.

Our Comments to the CMS and ONC

So, what did athenahealth contribute to the conversation? In our comments to CMS, we focused on:

• Why the implementation of Stage 2 should not be delayed
• Health Information Exchange
  • A logistically feasible, cross-vendor-and-organization alternative to the electronic provision of summary care record at transitions of care
  • Supply chain issues with incorporating lab results as structured data
• Patient Engagement
  • An alternative to the proposed secure messaging measure
  • Considerations for the implementation of View, Download, & Transmit
• How to aggregate data and attest with an EHR conversion

We also commented to the ONC about their Proposed Rule:

In addition to the nitty-gritty, technical issues, at a high level we also covered:

• Reporting on Patient Safety Events and the vendor’s role
• Support of a flexible and process-based approach to Quality Systems
• Ideas on how to facilitate data portability
• The importance of maintaining “Complete EHR” as a concept

Finally, we urged the ONC and CMS to continue driving transparency by a) continuing to make vendor, specialty and state attestation data publicly available; b) releasing registration-by-vendor data to inform providers during their EHR purchasing decisions; and, c) private-public sector collaboration.

So, now we wait. CMS will review 230 comments and the ONC will review 400. And what a range of comments they have to consider. To cite a few:

• The American Hospital Association has expressed its opinion that the proposed rule sets the bar for Stage 2 too high.
• The Electronic Health Record Association has also shared some concern about reporting requirements.
• Rep. Renee Ellmers, R-NC, a nurse who is married to a surgeon, asked CMS to exempt doctors from the Meaningful Use program who are in small practices or are close to retirement.

What do you think? How did you weigh in? We’ll keep you posted as the comments get reviewed during HIT Policy committee and HIT Standards committee meetings over the next couple of months. But now, we’d like to hear from you.

We are always happy to see coverage of electronic health records (EHR) pop up beyond medical or health IT news outlets. As a cloud-based service to medical practices and health care systems, we spend our time talking to those audiences because we are, well, trying to share the distinct benefits of our services. But an EHR is ultimately about an individual patient—and every patient should know more about the future of medical records.

So, recent coverage in the Boston Globe about EHR adoption got our attention. (As a company with a mantra about going paperless, a headline that says “Goodbye Paper” is particularly apt.)

The story included this infographic about the spread of EHR technology and the disbursement of federal incentive dollars under the Meaningful Use program.

And while it’s not exactly going to make the evening news, the Government Accountability Office just published a report on the first year of the Meaningful Use program. 

One of athenahealth’s concerns about the Meaningful Use program has been the lack of a method to verify that physicians across the country have met the measures. Thankfully, that’s not an issue for athenahealth. Since we operate in the cloud, we can see even the smallest grains of data in the network. In fact, we have been able to regularly report out on the progress of our client physicians on their path to Meaningful Use of an EHR as they met and attested to the measures.

While we can verify what physicians on our network do, how can that be done with software-based solutions, when they don’t afford the visibility of a cloud-based network? We hold ourselves to a high standard of integrity and we want to be sure that that the truly meaningful users get rewarded. It turns out that the government seems to agree and the auditors at the GAO would like to see a better process for verifying performance.

The GAO made the following recommendations to the Centers for Medicare & Medicaid Services (CMS), which administers the Meaningful Use program:

• Establish time frames for expeditiously implementing an evaluation of the effectiveness of the agency’s audit strategy for the Medicare EHR program.
• Evaluate the extent to which the agency should conduct more verifications on a prepayment basis when determining whether providers meet Medicare EHR program’s reporting requirements.
• Collect the additional information from Medicare providers during attestation that CMS suggested states collect from Medicaid providers during attestation.
• Offer states the option of having CMS collect meaningful use attestations from Medicaid providers on their behalf.

What do you think? How has the experience with Meaningful Use treated you and your practice of medicine?

This post originally appeared in Wired magazine’s Cloudline blog.

In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.

Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.

Why? I’ll give you one good reason and one bad one.

A countless number of companies and technologies and ideas were harmed — and, in fact, blown up completely — between the days of the brick Motorola cellphone and the iPhone of today. Remember “DSL” companies that connected houses to the internet over copper wire? Remember “booster antennae”? Remember when we all thought the “flip phone” was the shizzle?

There are many corpses scattered in the wake of the Internet and cellphone renaissance that has occurred over the past 20 years and we are all fine with that. The young engineers and designers that were part of exploding companies simply took their backpacks and mini-fridges and went to the next cool company. When the company worked out, the options for these young engineers and designers were worth millions. When it didn’t work out, they moved on.

But there’s a big difference when it comes to health care. If each of these companies had been dealing in critical patient information in an EMR and lives were at stake, this would have been a dangerous game. The innovation would have been faster but the collateral damage would probably have been too much for our social values.

OK, now here is the bad reason:

The market for exchanging information in health care, specifically for sending referrals, is, in many cases, not legal. I’m not kidding. A few years after we nationalized health care coverage for seniors (Medicare) and for those in need (Medicaid) in 1965, we also made it illegal for the sender of a patient to be given anything of value by the receiver of that patient.

There was a good reason for it as we were afraid of kickbacks driving up federally funded care. Well, federally funded care has gone up quite a lot since it was originally funded, but no supply chain emerged.

Cellphone carriers can pay retailers who hook up folks to their network, but specialists can’t pay primary care doctors for the effort required to send clean electronic clinical info over to them that would improve care and reduce duplication.

If they could, there would be a lot more than, like, six Wired readers using their engineering talents in health care. (Hi! Please come work at athenahealth.) Instead, the only information systems that people pay for are those that work within their own controlled environments. There are legacy, non-cloud software systems that are only useful for exchanging information within the institution that owns that particular IT system. Weird, right?

As a result, in the last three years, we have hospitals that bought an EMR under the HITECH Act (and Meaningful Use) that have also bought the practices of the doctors that use them! We have gone from some 22 percent of docs employed by hospitals in 2008 to about 44 percent employed by them today. Making people work for you in order to exchange information with them is not exactly New Age. And most of those doctor acquisitions will fall apart in the next three years. You heard it here first.

The good news is that, even despite these obstacles, the obvious benefits of cloud computing, especially through electronic medical records, are driving health care into the 21st century. We at athenahealth are growing like crazy and we serve all our clients on one single instance of our web-native application. We are also being asked by our clients to move information in and out of legacy systems that don’t communicate well. We have even gotten the federal government — the Office of the Inspector General in the Department of Health and Human Services, to be exact — to bless a small ($1) interchange fee as “NOT a kickback” in order to attract more entrepreneurial energy into the efficient exchange of clean health information.

All of this makes me feel like heady times are ahead in health care. Even though we are watched by a nervous, panicky government that doesn’t quite get the deets, enough good seems to be getting done for Uncle Sam to continue letting us move about the cabin. And the government is getting behind the cloud — or, at the very least, not getting in the way of it.

So, people of Wired, come to health care! The water is, well, a little chilly, but it’s getting warmer all the time. In fact, I’d say spring really is here!

To say Florida Woman Care has been an expanding medical practice across the Sunshine State would be an understatement. At the end of 2009, its first year in business, Florida Woman Care had 38 physicians. After its second year, that number grew to 158. The practice now has some 260 physicians and almost 400 total clinical providers on staff, at locations across the state from Pensacola to Miami.

When Florida Woman Care was looking for physician billing services and an EMR that would support its growth goals, the leadership wanted a solution that allowed them to drill down into data, get paid efficiently and avoid running the practice like a patient conveyor belt.

Find out how Florida Woman Care has made the most of athenahealth’s cloud-based services to satisfy these needs.